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Health and Care Act 2022: 10 Key Changes to the NHS in England
The Health and Care Act 2022 received Royal Assent on 28 April 2022 and reshapes how health and care services are planned, commissioned and delivered in England. Drawing on the official legislation, government impact assessments, and independent analysis from the King's Fund and NHS Alliance, here are 14 candidate facts that capture the Act’s core provisions.
The Health and Care Act 2022 is the most significant NHS reform in a decade. It merges NHS England with NHS Improvement, puts Integrated Care Systems on a statutory footing, introduces a triple aim duty, and shifts the system from competition to collaboration.
Act received Royal Assent on 28 April 2022
The Health and Care Act 2022 (c. 31) became law on 28 April 2022 after passing through both Houses of Parliament. It is the primary legislative vehicle for the biggest structural reforms to the NHS in England since the Health and Social Care Act 2012. Commencement of individual provisions occurs on various dates set by secondary legislation.
NHS Commissioning Board renamed NHS England
Section 1 of the Act formally renames the NHS Commissioning Board as NHS England. This change aligns the statutory name with the brand used since 2013 and reflects the body’s expanded role following the merger with NHS Improvement.
Merger of NHS England and NHS Improvement
The Act merges NHS England and NHS Improvement into a single national leadership body. This consolidation aims to reduce duplication, streamline national oversight, and support integrated care at system level. The merged entity retains the name NHS England.
Integrated Care Systems placed on statutory footing
The Act establishes Integrated Care Systems (ICSs) as legal entities comprising an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). ICBs take on commissioning and oversight of most NHS services in their geography, accountable to NHS England for spending and performance. ICPs bring together NHS, local authorities and wider partners to develop a joint health and care strategy.
Triple aim duty on wider effects of decisions
A new duty requires NHS England and ICBs to have regard to the wider effects of their decisions – the so‑called triple aim of better health and wellbeing, better quality of services, and sustainable use of resources. This embeds population health and value into everyday decision‑making.
Statutory duties to reduce health inequalities
Sections 6 and 11 impose duties on NHS England and ICBs to reduce inequalities in access to and outcomes from health services. They must also publish information on inequalities, making transparency a legal requirement rather than a policy aspiration.
Cancer outcome targets in NHS England mandate
Section 5 obliges the Secretary of State to set cancer outcome targets within the NHS England mandate. This aims to drive improvements in early diagnosis and survival rates, making cancer performance a formal condition of the national mandate.
Duty on NHS England regarding climate change
Section 9 places a duty on NHS England to have regard to the need to reduce greenhouse gas emissions and adapt to climate change. This aligns the NHS with the UK’s net‑zero commitments and makes environmental sustainability a statutory consideration.
Public involvement duties extended to carers and representatives
Section 10 expands the public involvement duty to explicitly include carers and representatives of people who use services. This strengthens the voice of patients and their supporters in commissioning and service design decisions.
Healthcare Safety Investigation Branch put on statutory footing
The Act establishes the Healthcare Safety Investigation Branch (HSIB) as a statutory body, independent of NHS England, to conduct safety investigations and share learning across the system. This responds to recommendations from the Paterson Inquiry and others.
Every numbered claim above was required to carry source evidence before this topic could be published.